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Pugh P, Hemingway P, Christian M, Higginbottom G. Key stakeholders' perspectives on the development of an early dietary phosphate self-management strategy for children and young people with chronic kidney disease stages 1-3: A modified Delphi consensus process. J Hum Nutr Diet 2024. [PMID: 38739861 DOI: 10.1111/jhn.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/29/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND An early dietary phosphate intervention (EPI) can provide vital medical benefits supporting self-management of chronic kidney disease (CKD) in childhood. OBJECTIVE To utilise expert consensus to provide early modelling for an EPI to guide clinical practice across a paediatric renal network. METHODS Forty-eight statements across six domains were constructed following a systematic review and semi-structured interviews with children and young people (CYP), parents and healthcare professionals (HCP). A three-round online Delphi survey with parents and paediatric renal multi-disciplinary healthcare experts was undertaken. RESULTS Twenty-one experts agreed on 56 statements over three Delphi rounds. Statements were accepted in all six domains: definition of an EPI (2), rationale (12), intended users (3), delivery (14) (when [1], where [3], who [2], how [8]), other considerations (16) and potential concerns (9). CONCLUSIONS Consensus was reached on a definition and a set of guiding principles, providing some early modelling for implementation and future research on the development of an EPI strategy for CYP with CKD.
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Affiliation(s)
- Pearl Pugh
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK
| | - Pippa Hemingway
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Martin Christian
- Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK
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Owen R, Ashton RE, Ferraro FV, Skipper L, Bewick T, Leighton P, Phillips BE, Faghy MA. Forming a consensus opinion to inform long COVID support mechanisms and interventions: a modified Delphi approach. EClinicalMedicine 2023; 62:102145. [PMID: 37599906 PMCID: PMC10432807 DOI: 10.1016/j.eclinm.2023.102145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background Current approaches to support patients living with post-COVID condition, also known as Long COVID, are highly disparate with limited success in managing or resolving a well-documented and long-standing symptom burden. With approximately 2.1 million people living with the condition in the UK alone and millions more worldwide, there is a desperate need to devise support strategies and interventions for patients. Methods A three-round Delphi consensus methodology was distributed internationally using an online survey and was completed by healthcare professionals (including clinicians, physiotherapists, and general practitioners), people with long COVID, and long COVID academic researchers (round 1 n = 273, round 2 n = 186, round 3 n = 138). Across the three rounds, respondents were located predominantly in the United Kingdom (UK), with 17.3-15.2% (round 1, n = 47; round 2 n = 32, round 2 n = 21) of respondents located elsewhere (United States of America (USA), Austria, Malta, United Arab Emirates (UAE), Finland, Norway, Malta, Netherlands, Iceland, Canada, Tunisie, Brazil, Hungary, Greece, France, Austrailia, South Africa, Serbia, and India). Respondents were given ∼5 weeks to complete the survey following enrolment, with round one taking place from 02/15/2022 to 03/28/22, round two; 05/09/2022 to 06/26/2022, and round 3; 07/14/2022 to 08/09/2022. A 5-point Likert scale of agreement was used and the opportunity to include free text responses was provided in the first round. Findings Fifty-five statements reached consensus (defined as >80% agree and strongly agree), across the domains of i) long COVID as a condition, ii) current support and care available for long COVID, iii) clinical assessments for long COVID, and iv) support mechanisms and rehabilitation interventions for long COVID, further sub-categorised by consideration, inclusion, and focus. Consensus reached proposes that long COVID requires specialised, comprehensive support mechanisms and that interventions should form a personalised care plan guided by the needs of the patients. Supportive approaches should focus on individual symptoms, including but not limited to fatigue, cognitive dysfunction, and dyspnoea, utilising pacing, fatigue management, and support returning to daily activities. The mental impact of living with long COVID, tolerance to physical activity, emotional distress and well-being, and research of pre-existing conditions with similar symptoms, such as myalgic encephalomyelitis, should also be considered when supporting people with long COVID. Interpretation We provide an outline that achieved consensus with stakeholders that could be used to inform the design and implementation of bespoke long COVID support mechanisms. Funding None.
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Affiliation(s)
- Rebecca Owen
- Biomedical and Clinical Science Research Theme, School of Human Sciences, University of Derby, Derby, UK
| | - Ruth E.M. Ashton
- Biomedical and Clinical Science Research Theme, School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection Network (HL-Pivot), USA
| | - Francesco V. Ferraro
- Biomedical and Clinical Science Research Theme, School of Human Sciences, University of Derby, Derby, UK
| | - Lindsay Skipper
- Patient and Public Involvement and Engagement Representative, UK
| | - Tom Bewick
- Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Nottingham and Derby, UK
| | | | - Mark A. Faghy
- Biomedical and Clinical Science Research Theme, School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection Network (HL-Pivot), USA
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He H, Yan J, Li J. Social sports in an aging society: Exercising, recreation and rehabilitation for the elderly. Geriatr Gerontol Int 2023; 23:98-102. [PMID: 36577544 DOI: 10.1111/ggi.14529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/17/2022] [Accepted: 12/02/2022] [Indexed: 12/30/2022]
Abstract
AIM This paper analyzes the adaptive changes that take place in mature and elderly women with different track records in social sports in order to develop health and rehabilitation techniques based on personalized and groupwise approaches. METHODS This longitudinal study was conducted between 2009 and 2019 in Zhengzhou, China. The sample consisted of 24 mature and elderly women (45-65 years old) in the experimental group (regular social sports) and 40 women of the same age who did not exercise (control group). The experimental group received physiotherapy twice a week. The sessions were scheduled for 10 a.m. and lasted for 3 h. The functional status of cardiovascular system parameters (blood pressure, heart rate) was measured. In addition, the physical working capacity (PWC 150), as well as the coefficient of body adaptation to stress and the Robinson index (the amount of oxygen required by the human body to function) were estimated. RESULTS Women from the experimental group maintained stable coefficients of adaptation during all 10 years over which the study was conducted. Women with a long track record (up to 10 years) revealed a slight increase in the body's functional capacity (P ≤ 0.05 with control). More than 50% of the women in the experimental group had cardiovascular measurements within or above the normal range, whereas the opposite was true in the control group. CONCLUSIONS The longitudinal study revealed upward trends of physical working capacity indicators, which can slow down involutional changes in the body. In some cases, the body's functional capacity may be improved. Geriatr Gerontol Int 2023; 23: 98-102.
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Affiliation(s)
- Huagang He
- College of Sports Science, Woosuk University, Jeonju, South Korea
| | - Jianhua Yan
- College of Physical Education, Henan University, Kaifeng, China
| | - Junhui Li
- College of Physical Education, Henan University, Kaifeng, China
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The Effect of Chair-Based Exercises on Exercise Perception and Risk of Falling in Inactive Older Adults Who Live at Nursing Home. TOPICS IN GERIATRIC REHABILITATION 2023. [DOI: 10.1097/tgr.0000000000000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Price J, Rushton A, Tyros V, Heneghan NR. Expert consensus on the important chronic non-specific neck pain motor control and segmental exercise and dosage variables: An international e-Delphi study. PLoS One 2021; 16:e0253523. [PMID: 34197481 PMCID: PMC8248695 DOI: 10.1371/journal.pone.0253523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Chronic non-specific neck pain is highly prevalent, resulting in significant disability. Despite exercise being a mainstay treatment, guidance on optimal exercise and dosage variables is lacking. Combining submaximal effort deep cervical muscles exercise (motor control) and superficial cervical muscles exercise (segmental) reduces chronic non-specific neck pain, but evaluation of optimal exercise and dosage variables is prevented by clinical heterogeneity. OBJECTIVE To gain consensus on important motor control and segmental exercise and dosage variables for chronic non-specific neck pain. METHODS An international 3-round e-Delphi study, was conducted with experts in neck pain management (academic and clinical). In round 1, exercise and dosage variables were obtained from expert opinion and clinical trial data, then analysed thematically (two independent researchers) to develop themes and statements. In rounds 2 and 3, participants rated their agreement with statements (1-5 Likert scale). Statement consensus was evaluated using progressively increased a priori criteria using descriptive statistics. RESULTS Thirty-seven experts participated (10 countries). Twenty-nine responded to round 1 (79%), 26 round 2 (70%) and 24 round 3 (65%). Round 1 generated 79 statements outlining the interacting components of exercise prescription. Following rounds 2 and 3, consensus was achieved for 46 important components of exercise and dosage prescription across 5 themes (clinical reasoning, dosage variables, exercise variables, evaluation criteria and progression) and 2 subthemes (progression criteria and progression variables). Excellent agreement and qualitative data supports exercise prescription complexity and the need for individualised, acceptable, and feasible exercise. Only 37% of important exercise components were generated from clinical trial data. Agreement was highest (88%-96%) for 3 dosage variables: intensity of effort, frequency, and repetitions. CONCLUSION Multiple exercise and dosage variables are important, resulting in complex and individualised exercise prescription not found in clinical trials. Future research should use these important variables to prescribe an evidence-informed approach to exercise.
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Affiliation(s)
- Jonathan Price
- Musculoskeletal Physiotherapy Services, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom
- College of Life and Environmental Sciences, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alison Rushton
- College of Life and Environmental Sciences, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Physical Therapy, Western University, Ontario, Canada
| | | | - Nicola R. Heneghan
- College of Life and Environmental Sciences, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Anderson AM, Comer C, Smith TO, Drew BT, Pandit H, Antcliff D, Redmond AC, McHugh GA. Consensus on pre-operative total knee replacement education and prehabilitation recommendations: a UK-based modified Delphi study. BMC Musculoskelet Disord 2021; 22:352. [PMID: 33853564 PMCID: PMC8044503 DOI: 10.1186/s12891-021-04160-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Over 90,000 total knee replacement (TKR) procedures are performed annually in the United Kingdom (UK). Patients awaiting TKR face long delays whilst enduring severe pain and functional limitations. Almost 20% of patients who undergo TKR are not satisfied post-operatively. Optimising pre-operative TKR education and prehabilitation could help improve patient outcomes pre- and post-operatively; however, current pre-operative TKR care varies widely. Definitive evidence on the optimal content and delivery of pre-operative TKR care is lacking. This study aimed to develop evidence- and consensus-based recommendations on pre-operative TKR education and prehabilitation. METHODS A UK-based, three-round, online modified Delphi study was conducted with a 60-member expert panel. All panellists had experience of TKR services as patients (n = 30) or professionals (n = 30). Round 1 included initial recommendations developed from a mixed methods rapid review. Panellists rated the importance of each item on a five-point Likert scale. Panellists could also suggest additional items in Round 1. Rounds 2 and 3 included all items from Round 1, new items suggested in Round 1 and charts summarising panellists' importance ratings from the preceding round. Free-text responses were analysed using content analysis. Quantitative data were analysed descriptively. All items rated as 'Important' or 'Very important' by at least 70% of all respondents in Round 3 were included in the final set of recommendations. RESULTS Fifty-five panellists (92%) (patients n = 26; professionals n = 29) completed Round 3. Eighty-six recommendation items were included in Round 1. Fifteen new items were added in Round 2. Rounds 2 and 3 therefore included 101 items. Seventy-seven of these reached consensus in Round 3. Six items reached consensus amongst patient or professional panellists only in Round 3. The final set of recommendations comprises 34 education topics, 18 education delivery approaches, 10 exercise types, 13 exercise delivery approaches and two other treatments. CONCLUSIONS This modified Delphi study developed a comprehensive set of recommendations that represent a useful resource for guiding decision-making on the content and delivery of pre-operative TKR education and prehabilitation. The recommendations will need to be interpreted and reviewed periodically in light of emerging evidence.
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Affiliation(s)
- Anna M Anderson
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - Christine Comer
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Community Healthcare NHS Trust Musculoskeletal and Rehabilitation Services, Leeds, UK
| | - Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Benjamin T Drew
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK
- Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, England, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
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Stojanović MDM, Mikić MJ, Milošević Z, Vuković J, Jezdimirović T, Vučetić V. Effects of Chair-Based, Low-Load Elastic Band Resistance Training on Functional Fitness and Metabolic Biomarkers in Older Women. JOURNAL OF SPORTS SCIENCE AND MEDICINE 2021; 20:133-141. [PMID: 33707996 DOI: 10.52082/jssm.2021.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/08/2021] [Indexed: 01/08/2023]
Abstract
Strength training can improve myriad health parameters in elderly cohorts. Although potentially more appropriate for the elderly, low-load resistance training protocols have been less investigated. We aimed to examine the effects of 12 weeks of chair-based, low-load resistance training with elastic band (EBT) on functional fitness and metabolic biomarkers in older women. One hundred sixty-eight women were allocated randomly to an elastic band resistance training (EBT, n = 86, 75.7 ± 8.9 years, 71.3 ± 12.2 kg) or a control group (CON, n = 82, 74.5 ± 8.2years, 70.6 ± 12.0 kg). RT protocol consisted of periodized chair-based, low-load whole-body resistance exercises (2 sets, 12-15 repetitions, 40-60% of one repetition maximum-1RM) using an elastic band, twice weekly for 12 weeks. The resistance training program was generally designed to maintain internal load over time, provided with increasing intensity using various elastic bands (Thera-Band). Functional fitness (30-s Chair Stand,30-s Arm Curl, 2-min Step Test, Chair Sit-and-Reach, Back Scratch, 8-Foot Up-and-Go, Handgrip Strength) and metabolic markers (Fasting blood glucose, triglycerides, total cholesterol, high (HDL) and low (LDL) density lipoprotein) were measured before and after the training period. To detect pre/post intervention changes and between group- differences 2x2 repeated measures ANOVA was applied. Significant improvements over time for all fitness variables for EBT comparing to CON were obtained (F = 12.78, p < 0.05 for 30-s Chair Stand; F = 14.04, p < 0.05 for 30-s Arm Curl; F = 5.18, p < 0.05 for 2-min Step Test; F = 10.90, p < 0.05 for Chair Sit-and-Reach; F = 16.57, p < 0.05 for Back Scratch; F = 11.79, p < 0.05 for 8-foot Up-and-Go; and F = 29.25, p < 0.05 for Handgrip Strength). In addition, significant improvements over time for all but one (triglycerides) biomarkers for EBT comparing to CON were obtained (F = 7.30, p < 0.05 for blood sugar levels; F = 13.36, p < 0.05 for total cholesterol; F = 8.61, p < 0.05 for HDL; and F = 11.53, p < 0.05 for LDL). Furthermore, the participants' adherence to training sessions of over 90% was reported. In conclusion, 12 weeks of EBT is safe and beneficial for improving health-related fitness and metabolic biomarkers in older women and seems to be viable model to ensure a high training adherence rate.
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Affiliation(s)
- Marko D M Stojanović
- University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia.,Advanced Rehab & Conditioning Lab, Faculty of Sport and Physical Education, University of Novi Sad, Serbia
| | - Mladen J Mikić
- University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia.,Advanced Rehab & Conditioning Lab, Faculty of Sport and Physical Education, University of Novi Sad, Serbia
| | - Zoran Milošević
- University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Jovan Vuković
- University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Tatjana Jezdimirović
- University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia
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Klempel N, Blackburn NE, McMullan IL, Wilson JJ, Smith L, Cunningham C, O’Sullivan R, Caserotti P, Tully MA. The Effect of Chair-Based Exercise on Physical Function in Older Adults: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1902. [PMID: 33669357 PMCID: PMC7920319 DOI: 10.3390/ijerph18041902] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/13/2022]
Abstract
Physical activity is an important determinant of health in later life. The public health restrictions in response to COVID-19 have interrupted habitual physical activity behaviours in older adults. In response, numerous exercise programmes have been developed for older adults, many involving chair-based exercise. The aim of this systematic review was to synthesise the effects of chair-based exercise on the health of older adults. Ovid Medline, EMBASE, CINAHL, AMED, PyscInfo and SPORTDiscus databases were searched from inception to 1 April 2020. Chair-based exercise programmes in adults ≥50 years, lasting for at least 2 weeks and measuring the impact on physical function were included. Risk of bias of included studies were assessed using Cochrane risk of bias tool v2. Intervention content was described using TiDieR Criteria. Where sufficient studies (≥3 studies) reported data on an outcome, a random effects meta-analysis was performed. In total, 25 studies were included, with 19 studies in the meta-analyses. Seventeen studies had a low risk of bias and five had a high risk of bias. In this systematic review including 1388 participants, results demonstrated that chair-based exercise programmes improve upper extremity (handgrip strength: MD = 2.10; 95% CI = 0.76, 3.43 and 30 s arm curl test: MD = 2.82; 95% CI = 1.34, 4.31) and lower extremity function (30 s chair stand: MD 2.25; 95% CI = 0.64, 3.86). The findings suggest that chair-based exercises are effective and should be promoted as simple and easily implemented activities to maintain and develop strength for older adults.
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Affiliation(s)
- Natalie Klempel
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey BT37 0QB, UK; (N.K.); (N.E.B.); (I.L.M.); (J.J.W.)
| | - Nicole E. Blackburn
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey BT37 0QB, UK; (N.K.); (N.E.B.); (I.L.M.); (J.J.W.)
| | - Ilona L. McMullan
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey BT37 0QB, UK; (N.K.); (N.E.B.); (I.L.M.); (J.J.W.)
| | - Jason J. Wilson
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey BT37 0QB, UK; (N.K.); (N.E.B.); (I.L.M.); (J.J.W.)
- Sport and Exercise Sciences Research Institute, School of Sport, Newtownabbey BT37 0QB, UK
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey BT37 0QB, UK
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge CB1 1PT, UK;
| | - Conor Cunningham
- Institute of Public Health, City Exchange, 11–13 Gloucester St, Belfast BT1 4LS, UK;
| | - Roger O’Sullivan
- The Bamford Centre for Mental Health & Wellbeing Ulster University, Coleraine BT52 1SA, UK;
| | - Paolo Caserotti
- Centre for Active and Healthy Ageing, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
| | - Mark A. Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey BT37 0QB, UK
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Development of a Care Bundle for Stroke Survivors with Psychological Symptoms: Evidence Summary and Delphi Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:7836024. [PMID: 32714421 PMCID: PMC7345612 DOI: 10.1155/2020/7836024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 01/01/2023]
Abstract
Background Psychological symptoms such as depression and anxiety are quite common among stroke survivors and have great negative impacts on patients. Objective To develop a care bundle through reviewing and integrating care strategies for psychological symptoms after stroke and then improve the bundle by Delphi study. Methods A structured search of the literature was performed to identify studies evaluating interventions for stroke patients with psychological symptoms such as depression and anxiety. Two trained researchers screened papers through the titles, abstracts, and full-texts independently. All studies complying with the eligibility criteria were appraised using quality assessment tools. Related interventions with evaluated evidence levels formed the preliminary bundle. Afterward, the Delphi study was carried out to improve the bundle, and the experts were contacted by e-mail. Ten clinical experts specialized in stroke and psychological rehabilitation were recruited. The reliability of experts was represented by the effective response rate and authority coefficient (Cr). The consensus was deemed to be reached when the mean score for item importance is all equal or above 3.50 and the coefficient of variation (CV) is all equal or below 0.20. The Kendall coefficient W test was adopted to evaluate the consensus on agreement among the experts as well. Data analysis was performed using SPSS V.22.0. Results Through a systematic evidence summary and two-round Delphi study, the items that were given high scores and got consensus by experts were chosen for the bundle. The iDAME bundle consisted of five interventions eventually: maintaining Interaction, tailored Diet, Acupressure, mindfulness Meditation, and physical Exercise. Conclusion The development of an evidence-based and consensus-based iDAME bundle which integrated western and traditional Chinese medicine intervention was described. Evidence summary made the bundle become scientific, while the Delphi study made it more maneuverable. Based on these results, the bundle would be potentially implemented in stroke patients for their psychological symptoms.
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Fong W, Kwan YH, Yoon S, Phang JK, Thumboo J, Leung YY, Ng SC. Assessment of medical professionalism using the Professionalism Mini Evaluation Exercise (P-MEX) in a multi-ethnic society: a Delphi study. BMC MEDICAL EDUCATION 2020; 20:225. [PMID: 32664983 PMCID: PMC7362541 DOI: 10.1186/s12909-020-02147-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The importance of medical professionalism and its assessment has been well documented in the literature. However, there is currently no culturally-adapted tool to assess medical professionalism in Singapore. This study sets out to find consensus on relevance of the items from the Professionalism Mini Evaluation Exercise (P-MEX) for assessing medical professionalism in Singapore. METHODS A two-round Delphi survey was completed by an expert panel consisting of program directors, associate designated institutional officials, and designated institutional official (n = 15) from residency programs in Singapore. Round 1 comprised of 23 items from the P-MEX rated on a 5-point scale (1 = Definitely include, 2 = Possibly include, 3 = Neutral, 4 = Possibly exclude, 5 = Definitely exclude). In round 2, the experts received feedback from the previous round, and were asked to re-rate the items which did not achieve consensus in the previous round. The threshold for consensus in the study was defined as 70% or greater agreement among experts. RESULTS Completed questionnaires for both rounds were received from all 15 experts. In round 1, 18 items (78%) achieved consensus to be included. In round 2, 1 (4%) item achieved consensus to be included. However, none of the remaining items achieved consensus to be removed, and they exhibited stability in responses. A list of 19 items covering four domains of medical professionalism (Doctor-patient relationship skills, Reflective skills, Time management and Inter-professional relationship skills) was obtained during the two-rounds of Delphi survey. CONCLUSIONS Nineteen items in the P-MEX had garnered consensus and is suitable for assessing medical professionalism in Singapore. The findings of this study can provide guidance for faculty and institutions who want to assess medical professionalism of their medical trainees.
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Affiliation(s)
- Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Sungwon Yoon
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Swee Cheng Ng
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Price J, Rushton A, Tyros V, Heneghan NR. Consensus on the exercise and dosage variables of an exercise training programme for chronic non-specific neck pain: protocol for an international e-Delphi study. BMJ Open 2020; 10:e037656. [PMID: 32414832 PMCID: PMC7232615 DOI: 10.1136/bmjopen-2020-037656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Clinical guidelines and systematic reviews recommend exercise in the management of chronic non-specific neck pain. Although exercise training programmes that consist of both motor control exercise and exercises for the superficial cervical muscles (segmental exercises) are effective, the exercise variables including dosage vary considerably across trials or are poorly reported. This study aims to gain expert consensus on these exercise variables so that they can be described clearly using intervention reporting checklists to inform clinical practice and future clinical trials. METHODS AND ANALYSIS This protocol for an international Delphi study is informed by the Guidance on Conducting and REporting DElphi Studies recommendations and published to ensure quality, rigour and transparency. The study will consist of three rounds using anonymous online questionnaires. Expert exercise professionals (physiotherapists, strength and conditioning coaches and so on) and academics in neck pain management will be identified through literature searches, peer referral and social media calls for expression of interest. In round 1, participants will answer open-ended questions informed by intervention and exercise reporting checklists. Responses will be analysed thematically by two independent reviewers. In round 2, participants will rate their level of agreement with statements generated from round 1 and previous clinical trials using a 5-point Likert scale where 1=strongly disagree and 5=strongly agree. In round 3, participants will re-rate their agreement with statements that achieved consensus in round 2. Statements reaching consensus among participants must meet progressively increased a priori criteria at rounds 2 and 3, measured using descriptive statistics: median, IQR and percentage agreement. Inferential statistics will be used to evaluate measures of agreement between participants (Kendall's coefficient of concordance) and stability between rounds (Wilcoxon rank-sum test). Statements achieving consensus in round 3 will provide expert recommendations of the key exercise and dosage variables in the management of chronic non-specific neck pain. ETHICS AND DISSEMINATION Ethical approval was provided by the University of Birmingham Ethics Committee (Ref:ERN_19-1857). Results will be disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Jonathan Price
- Musculoskeletal Physiotherapy Services, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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12
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Furtado GE, Carvalho HM, Loureiro M, Patrício M, Uba-Chupel M, Colado JC, Hogervorst E, Ferreira JP, Teixeira AM. Chair-based exercise programs in institutionalized older women: Salivary steroid hormones, disabilities and frailty changes. Exp Gerontol 2020; 130:110790. [DOI: 10.1016/j.exger.2019.110790] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/02/2019] [Accepted: 11/20/2019] [Indexed: 11/25/2022]
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13
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van der Lee L, Hill AM, Patman S. Expert consensus for respiratory physiotherapy management of mechanically ventilated adults with community-acquired pneumonia: A Delphi study. J Eval Clin Pract 2019; 25:230-243. [PMID: 30565374 DOI: 10.1111/jep.13077] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 01/04/2023]
Abstract
RATIONALE AND AIMS Patients with community-acquired pneumonia (CAP) are frequently admitted to an intensive care unit. Physiotherapy may be provided to optimize respiratory function; however, there is significant variability in clinical practice and limited research directing best practice for this cohort. This study aimed to determine expert consensus for best physiotherapy practice for invasively ventilated adults with CAP. METHOD A modified Delphi technique involved an international expert panel completing three rounds of an online questionnaire. The initial 35-statement questionnaire, based on a systematic literature review and survey of current clinical practice, covered physiotherapy assessment and treatment of intubated patients with CAP. Quantitative data using Likert scales determined level of agreement, with qualitative data collected through open-ended responses. Consensus threshold was set a priori at 70%. Items not achieving consensus were modified and new items added based on themes from qualitative data. Quantitative data were analysed descriptively, with thematic analysis used on qualitative data. RESULTS The panel comprised 29 international clinical and academic experts in critical care physiotherapy. Response rate was more than 95% for each round. Outcome achieved was 38 consensus statements covering assessment and treatment, with 28 statements (74%) providing consensus on recommended clinical practice, two consensus disagreement statements (7%) for what practice is not recommended, and eight statements (21%) indicating which treatments may be beneficial. CONCLUSION Expert consensus regarding physiotherapy for intubated adults with CAP patients provides an evidence-based approach to guide clinical practice. The consensus statements can also be used to guide research evaluating physiotherapy interventions for patients with CAP.
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Affiliation(s)
- Lisa van der Lee
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia.,Intensive Care Unit, Fiona Stanley Hospital Perth, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Shane Patman
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
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14
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Rieping T, Furtado GE, Letieri RV, Chupel MU, Colado JC, Hogervorst E, Filaire E, Teixeira AMMB, Ferreira JP. Effects of Different Chair-Based Exercises on Salivary Biomarkers and Functional Autonomy in Institutionalized Older Women. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2019; 90:36-45. [PMID: 30722757 DOI: 10.1080/02701367.2018.1563272] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE The aim of this study was to test the effects of chair-based exercise programs on salivary stress hormones, physical fitness, and functional autonomy of institutionalized older women. METHOD In total, 47 participants (80 ± 8.04 years old) were recruited and allocated into three groups: chair-based aerobic exercises (CAE, n = 19), chair-based elastic-band strength exercises (CSE, n = 15), and a control group (CG, n = 13). A 14-week exercise intervention was done for the CAE and CSE groups, two times per week, in no consecutive days. Members of the CG did not participate in any type of exercise but kept their regular lifestyle. Fear of falling, autonomy, physical fitness, salivary cortisol, and alpha-amylase levels were assessed before and after the intervention. RESULTS The CAE group improved upper and lower body strength, agility-dynamic balance, and autonomy, with fear of falling decreasing significantly (p < .05, moderate effect size). Both exercise groups showed a trend toward an increase in salivary alpha-amylase levels (CAE = 43%, d = .31, and CSE = 44%, d = .41). CONCLUSION Both exercise programs were able to improve functional autonomy, even in elders older than 80 years of age. It might be interesting to investigate the effectiveness of combining both aerobic and strength exercises in a unique protocol. The modulation effect of exercise in the hormonal responses needs to be further explored.
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15
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Robinson KR, Long AL, Leighton P, Armstrong S, Pulikottill-Jacob R, Gladman JRF, Gordon AL, Logan P, Anthony KA, Harwood RH, Blackshaw PE, Masud T. Chair based exercise in community settings: a cluster randomised feasibility study. BMC Geriatr 2018; 18:82. [PMID: 29614960 PMCID: PMC5883353 DOI: 10.1186/s12877-018-0769-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Some older people who find standard exercise programmes too strenuous may be encouraged to exercise while remaining seated - chair based exercises (CBE). We previously developed a consensus CBE programme (CCBE) following a modified Delphi process. We firstly needed to test the feasibility and acceptability of this treatment approach and explore how best to evaluate it before undertaking a definitive trial. Methods A feasibility study with a cluster randomised controlled trial component was undertaken to 1. Examine the acceptability, feasibility and tolerability of the intervention and 2. Assess the feasibility of running a trial across 12 community settings (4 day centres, 4 care homes, 4 community groups). Centres were randomised to either CCBE, group reminiscence or usual care. Outcomes were collected to assess the feasibility of the trial parameters: level of recruitment interest and eligibility, randomisation, adverse events, retention, completion of health outcomes, missing data and delivery of the CCBE. Semi- structured interviews were conducted with participants and care staff following the intervention to explore acceptability. Results 48% (89 out of 184 contacted) of eligible centres were interested in participating with 12 recruited purposively. 73% (94) of the 128 older people screened consented to take part with 83 older people then randomised following mobility testing. Recruitment required greater staffing levels and resources due to 49% of participants requiring a consultee declaration. There was a high dropout rate (40%) primarily due to participants no longer attending the centres. The CCBE intervention was delivered once a week in day centres and community groups and twice a week in care homes. Older people and care staff found the CCBE intervention largely acceptable. Conclusion There was a good level of interest from centres and older people and the CCBE intervention was largely welcomed. The trial design and governance procedures would need to be revised to maximise recruitment and retention. If the motivation for a future trial is physical health then this study has identified that further work to develop the CCBE delivery model is warranted to ensure it can be delivered at a frequency to elicit physiological change. If the motivation for a future trial is psychological outcomes then this study has identified that the current delivery model is feasible. Trial registration ISRCTN27271501. Date registered: 30/01/2018. Electronic supplementary material The online version of this article (10.1186/s12877-018-0769-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K R Robinson
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK. .,Duncan McMillan House, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
| | - A L Long
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - P Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - S Armstrong
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - J R F Gladman
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (NIHR CLAHRC EM), Nottingham, UK.,Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK
| | - A L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (NIHR CLAHRC EM), Nottingham, UK.,Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK
| | - P Logan
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK
| | - K A Anthony
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK
| | - R H Harwood
- Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK.,Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - P E Blackshaw
- Medical Physics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T Masud
- Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK.,Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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16
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Xu Q, Huang Y, Chen B. Comprehensive assessment of health education and health promotion in five non-communicable disease demonstration districts in China: a cross-sectional study. BMJ Open 2017; 7:e015943. [PMID: 29282256 PMCID: PMC5770822 DOI: 10.1136/bmjopen-2017-015943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES This study aims to develop assessment indicators of health education and promotion for non-communicable disease (NCD) demonstration districts in China and to identify significant factors associated with NCD health education and promotion work. METHODS Three complementary techniques were used to conduct this study in Hunan Province, China, between late 2013 and 2015. The Delphi technique was used to develop weighted assessment indicators, followed by the rank sum ratio (RSR) to normalise the weights through rank conversion. Lastly, the technique for order of preference by similarity to ideal solution was conducted to assess five randomly selected NCD demonstration districts representing five different orientations in the province. RESULTS A total of 24 assessment indicators were constructed covering the following sections: organisational management, fund support, personnel supplies, health education and promotion, people's awareness of NCDs, management and control of patients with NCD, satisfaction with health education and promotion and health literacy of residents. Five districts were selected as samples for evaluation (Furong District, Ziyang District, Shaodong County, Shuangfeng County and Luxi County). Performance varied among the sites, with Furong District greatly surpassing the other sites, especially in fund support, media promotion, technical support for publicity materials, community promotion and supportive environment supplies. The latter four factors were also much greater in the second-ranked Luxi County site than those in the other sites (except Furong District). CONCLUSIONS There were gaps in health education and promotion work in NCD demonstration districts in Hunan Province. The districts that performed better had obvious advantages in fund support, media promotion, technical support, community promotion and supportive environment supplies. Our study provided both a methodological reference and an assessment indicator framework for similar future studies.
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Affiliation(s)
- Qiaohua Xu
- Department of Chronic Disease Control and Prevention, Hunan Provincial Centre for Diseases Control and Prevention, Changsha, China
| | - Yuelong Huang
- Department of Chronic Disease Control and Prevention, Hunan Provincial Centre for Diseases Control and Prevention, Changsha, China
| | - Biyun Chen
- Department of Chronic Disease Control and Prevention, Hunan Provincial Centre for Diseases Control and Prevention, Changsha, China
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Cancela Carral JM, Pallin E, Orbegozo A, Ayán Pérez C. Effects of Three Different Chair-Based Exercise Programs on People Older Than 80 Years. Rejuvenation Res 2017; 20:411-419. [PMID: 28482740 DOI: 10.1089/rej.2017.1924] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This study aimed at comparing the effects of three chair-based exercise programs on people older than 80 years. Thirty-six participants (87.91 ± 4.70 years) were randomly allocated to an aerobic, muscular resistance, or joint mobility exercise program. The participants exercised 3 days per week during 3 months. A hand-held dynamometer, the Tinetti Gait Balance, the Barthel Index, and the Timed Up and Go Test (TUG) (assessed by means of the Wiva® science sensor) were used to evaluate the effects of the programs on the participants' strength, balance, functional independence, and functional mobility, respectively. After the intervention, it was observed that only the elastic-band program resulted in significant improvements in strength and balance. These results imply that when choosing a low-cost exercise program for very old people, the use of elastic bands stands as a far better option than pedaling on a pedal exerciser or performing mobility exercises.
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Affiliation(s)
- José M Cancela Carral
- 1 HealthyFit Research Group, University of Vigo , Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-UVIGO, Pontevedra, Spain .,2 Faculty of Education and Sport Sciences, Sport Sciences, University of Vigo , Pontevedra, Spain
| | - Estrella Pallin
- 2 Faculty of Education and Sport Sciences, Sport Sciences, University of Vigo , Pontevedra, Spain
| | - Ander Orbegozo
- 2 Faculty of Education and Sport Sciences, Sport Sciences, University of Vigo , Pontevedra, Spain
| | - Carlos Ayán Pérez
- 1 HealthyFit Research Group, University of Vigo , Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-UVIGO, Pontevedra, Spain .,2 Faculty of Education and Sport Sciences, Sport Sciences, University of Vigo , Pontevedra, Spain
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18
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Marques M, Chupel MU, Furtado GE, Minuzzi LG, Rosado F, Pedrosa F, Ferreira JP, Teixeira AM. Influence of chair-based yoga on salivary anti-microbial proteins, functional fitness, perceived stress and well-being in older women: A pilot randomized controlled trial. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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19
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Instructors' Perceptions of Mostly Seated Exercise Classes: Exploring the Concept of Chair Based Exercise. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3241873. [PMID: 27990426 PMCID: PMC5136379 DOI: 10.1155/2016/3241873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/12/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
Abstract
Chair based exercise (CBE) can be used to engage older adults unable to take part in standing exercise programmes. Defining and understanding the context of CBE have been acknowledged as a challenge. We explore instructor experiences of delivering mostly seated exercise classes for older people and how this helps us to further understand the concept of CBE. We extracted qualitative data from a cross-sectional survey with 731 exercise instructors. 378 delivered mostly seated classes and 223 of those instructors provided qualitative data. There were 155 instructors who did not provide any qualitative comments. Framework analysis was used and informed by a Delphi consensus study on CBE. Instructors perceived mostly seated classes as predominantly CBE; they defined it as an introductory class that should be offered as part of a continuum of exercise. It was considered suitable for those with limitations and older adults in long-term care and with dementia. Instructors reported CBE used inappropriately for more active older people. Instructors reported observing improvements in mood and cognition and broader social benefits. Instructors' perspectives largely support expert consensus that CBE has an important role in a continuum of exercise. Providers of CBE need to ensure that more challenging exercises are introduced where appropriate. Further research is needed to explore older adults' perceptions of CBE.
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Teixeira AM, Ferreira JP, Hogervorst E, Braga MF, Bandelow S, Rama L, Figueiredo A, Campos MJ, Furtado GE, Chupel MU, Pedrosa FM. Study Protocol on Hormonal Mediation of Exercise on Cognition, Stress and Immunity (PRO-HMECSI): Effects of Different Exercise Programmes in Institutionalized Elders. Front Public Health 2016; 4:133. [PMID: 27446898 PMCID: PMC4921497 DOI: 10.3389/fpubh.2016.00133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/13/2016] [Indexed: 11/13/2022] Open
Abstract
Physical activity (PA) in elders has been shown to have positive effects on a plethora of chronic diseases and to improve immunity, mental health, and cognition. Chronic stress has also been shown to have immuno-suppressive effects and to accelerate immunosenescence. Exercise could be a significant factor in ameliorating the deleterious effects of chronic stress, but variables such as the type, intensity, and frequency of exercise that should be performed in order to effectively reduce the stress burden need to be defined clearly. PRO-HMECSI will allow us to investigate which hormonal and immunological parameters are able to mediate the effects of exercise on mucosal immunity, psychological/biological stress, and cognitive functioning in older people. Phase I consists of an observational cross-sectional study that compares elders groups (n = 223, >65 years) by functional fitness levels aiming to identify biomarkers involved in maintaining immune and mental health. Neuroendocrine and immune biomarkers of stress, psychological well-being related to mental health, neurocognitive function, functional fitness, and daily PA will be evaluated. Phase II consists of a 28-week intervention in elders with mild cognitive impairment (MCI) profile (n = 149, >65 years, divided in three groups of exercise and one control group), aiming to investigate whether the positive effect of three different types of chair-based exercise programs on physical and psychological health is mediated by an optimal endocrine environment. Primary outcomes are measures of cognitive function and global health. Secondary outcomes include the evaluation the other dimensions such as immune function, psychological health, and depression. Few studies addressed the effects of different types of exercise interventions in older population samples with MCI. We will also be able to determine which type of exercise is more effective in the immune and hormonal function of this population.
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Affiliation(s)
- Ana Maria Teixeira
- Faculty of Sport Sciences and Physical Education, University of Coimbra , Coimbra , Portugal
| | - José Pedro Ferreira
- Faculty of Sport Sciences and Physical Education, University of Coimbra , Coimbra , Portugal
| | - Eef Hogervorst
- National Centre for Sports and Exercise Medicine, Loughborough University , Loughborough , UK
| | - Margarida Ferreira Braga
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, Porto University , Porto , Portugal
| | - Stephan Bandelow
- National Centre for Sports and Exercise Medicine, Loughborough University , Loughborough , UK
| | - Luís Rama
- Faculty of Sport Sciences and Physical Education, University of Coimbra , Coimbra , Portugal
| | - António Figueiredo
- Faculty of Sport Sciences and Physical Education, University of Coimbra , Coimbra , Portugal
| | - Maria João Campos
- Faculty of Sport Sciences and Physical Education, University of Coimbra , Coimbra , Portugal
| | - Guilherme Eustáquio Furtado
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal; CAPES Foundation, Ministry of Education, Brasilia, Brazil
| | - Matheus Uba Chupel
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal; CAPES Foundation, Ministry of Education, Brasilia, Brazil
| | - Filipa Martins Pedrosa
- Faculty of Sport Sciences and Physical Education, University of Coimbra , Coimbra , Portugal
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